1, partial amputations of the third and fifth metatarsals; 2, disarticulation of the first and fifth metatarsals. (Mignon and Matas.)
Fig. 694
Tracings of intratarsal amputations at various levels (outer side): 1, subastragaloid; 2, tibiotarsal; 3, tibiocalcaneal; the different lengths of flaps shown in relation to skeleton.
Fig. 695
Tracings of incisions in mediotarsal amputations and total amputation of fifth toe. (Mignon and Matas.)
For my own part I would advise to save all of a foot that can be saved, providing a sufficiently long plantar or heel flap can be retained; but if these are not available, then I would advise amputation, at least three inches above the ankle.
I would advise, moreover, to discard the complicated rules and technique of stilted methods and to use the saw whenever it can be made useful, rather than to go farther back to a row of joints simply because they are joints ([Fig. 694]).
[Figs. 695] and [696] illustrate conservative modern methods, which are perfectly available for most purposes, and from which departure need be made only when peculiar circumstances obtain, which so complicate the case that none of the ordinary rules would apply. A surgeon of judgment and experience is competent to devise a flap for a given case, whether it complies with standard methods or not. It seems to me, therefore, worth while to describe only the so-called mediotarsal disarticulation of Chopart, in which but the astragalus and calcis remain of the proper bones of the foot. The joint line extends from just behind the tuberosity of the scaphoid to the outer side of the body of the calcis, where a tubercle can be usually felt. Across this line an incision is carried obliquely over the dorsum of the foot. The plantar flap is the long one, and the line of division is just behind the balls of the toes. Two lateral incisions can be made to facilitate disarticulation if desirable.